TY - JOUR
T1 - Predictors of reincarceration and disease progression among released HIV-infected inmates
AU - Baillargeon, Jacques
AU - Giordano, Thomas P.
AU - Harzke, Amy Jo
AU - Spaulding, Anne C.
AU - Wu, Z. Helen
AU - Grady, James J.
AU - Baillargeon, Gwen
AU - Paar, David P.
PY - 2010/6/1
Y1 - 2010/6/1
N2 - We conducted a retrospective cohort study to determine the 3-year reincarceration rate of all HIV-infected inmates (n=1917) released from the Texas prison system between January 2004 and March 2006. We also analyzed postrelease changes in HIV clinical status in the subgroup of inmates who were subsequently reincarcerated and had either CD4 lymphocyte counts (n=119) or plasma HIV RNA levels (n=122) recorded in their electronic medical record at both release and reincarceration. Multivariable analyses were performed to assess predictors of reincarceration and clinical changes in HIV status. Only 20% of all HIV-infected inmates were reincarcerated within 3 years of release. Female inmates (hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.47, 0.84) and inmates taking antiretroviral therapy at the time of release (HR 0.31; 95% CI, 0.25, 0.39) were at decreased risk of reincarceration. African Americans (HR 1.58; 95% CI, 1.22, 2.05), inmates with a major psychiatric disorder (HR 1.82; 95% CI, 1.41, 2.34), and inmates released on parole (HR 2.86; 95% CI, 2.31, 3.55) were at increased risk of reincarceration. A subgroup of reincarcerated inmates had a mean decrease in CD4 cell count of 79.4 lymphocytes per microliter (p<0.0003) and a mean increase in viral load of 1.5 log 10 copies per milliliter (p<0.0001) in the period between release and reincarceration. Our findings, although substantially limited by selection bias, highlight the importance of developing discharge planning programs to improve linkage to community-based HIV care and reduce recidivism among released HIV-infected inmates.
AB - We conducted a retrospective cohort study to determine the 3-year reincarceration rate of all HIV-infected inmates (n=1917) released from the Texas prison system between January 2004 and March 2006. We also analyzed postrelease changes in HIV clinical status in the subgroup of inmates who were subsequently reincarcerated and had either CD4 lymphocyte counts (n=119) or plasma HIV RNA levels (n=122) recorded in their electronic medical record at both release and reincarceration. Multivariable analyses were performed to assess predictors of reincarceration and clinical changes in HIV status. Only 20% of all HIV-infected inmates were reincarcerated within 3 years of release. Female inmates (hazard ratio [HR] 0.63; 95% confidence interval [CI], 0.47, 0.84) and inmates taking antiretroviral therapy at the time of release (HR 0.31; 95% CI, 0.25, 0.39) were at decreased risk of reincarceration. African Americans (HR 1.58; 95% CI, 1.22, 2.05), inmates with a major psychiatric disorder (HR 1.82; 95% CI, 1.41, 2.34), and inmates released on parole (HR 2.86; 95% CI, 2.31, 3.55) were at increased risk of reincarceration. A subgroup of reincarcerated inmates had a mean decrease in CD4 cell count of 79.4 lymphocytes per microliter (p<0.0003) and a mean increase in viral load of 1.5 log 10 copies per milliliter (p<0.0001) in the period between release and reincarceration. Our findings, although substantially limited by selection bias, highlight the importance of developing discharge planning programs to improve linkage to community-based HIV care and reduce recidivism among released HIV-infected inmates.
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U2 - 10.1089/apc.2009.0303
DO - 10.1089/apc.2009.0303
M3 - Article
C2 - 20565323
AN - SCOPUS:77954209901
SN - 1087-2914
VL - 24
SP - 389
EP - 394
JO - AIDS Patient Care and STDs
JF - AIDS Patient Care and STDs
IS - 6
ER -